Ivonne
Find a way or make one
Topics: 58
Posts: 1,611
|
Which medication can cause new onset atrial fibrillation and hands tremor during the treatment of elderly patients with hyperthyroidism:
1.-propanolol
2.-iopanoic acid
3.-radiactive iodine
4.-Propylthiouracil (PTU)
5.-methimazol
and what to do to avoid this complication?
___________________
92/99/pass/ECFMG certified/4 US LoRs/GC/extensive USCE/2004 grad/appl 29 IM Prog, IV/Rej: 3/0 "I must, I can and I will"
|
| new_n_lost
Forum Hero
Topics: 663
Posts: 6,107
|
1.-propanolol ??
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| Ivonne
Find a way or make one
Topics: 58
Posts: 1,611
|
explain your answer please
___________________
92/99/pass/ECFMG certified/4 US LoRs/GC/extensive USCE/2004 grad/appl 29 IM Prog, IV/Rej: 3/0 "I must, I can and I will"
|
| new_n_lost
Forum Hero
Topics: 663
Posts: 6,107
|
Well there is an escape phenomenon with propanolol. i had read it some where so i thought of it. I will also look it up.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| Luckyall
Forum Guru
Topics: 11
Posts: 593
|
i think is Propranolol
With chronic use of beta block.---> there is Rec upregulation--> it means more beta Rec. ready to be activated by circulating CA---> mugged stimulation of heart--> excessive CVS effects such cardiac arrythm.& sudden cardiac death
|
| Luckyall
Forum Guru
Topics: 11
Posts: 593
|
and wht to do to avoid? just gradually lower the dose ( taper dose) to avoid these rebound effects of endogenous CA
|
| Ivonne
Find a way or make one
Topics: 58
Posts: 1,611
|
can it cause hands tremor too?
___________________
92/99/pass/ECFMG certified/4 US LoRs/GC/extensive USCE/2004 grad/appl 29 IM Prog, IV/Rej: 3/0 "I must, I can and I will"
|
| new_n_lost
Forum Hero
Topics: 663
Posts: 6,107
|
2.-iopanoic acid
Found it. There is a definite escape phenomenon with Iodine and its products in Hyperthyroid pts. (Emedicine).
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| Ivonne
Find a way or make one
Topics: 58
Posts: 1,611
|
___________________
92/99/pass/ECFMG certified/4 US LoRs/GC/extensive USCE/2004 grad/appl 29 IM Prog, IV/Rej: 3/0 "I must, I can and I will"
|
| hanialkhadher
Forum Elite
Topics: 18
Posts: 259
|
Well i am not sure if it is applicable here but i think it may be something like Jod-Basedow disease. so i will go with:
Iopanoic acid 
___________________
"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
|
| Ivonne
Find a way or make one
Topics: 58
Posts: 1,611
|
But iopanoid acid(telepaque) is a contrast medium used for diagnosis not in the treatment of hyperthyroidism in the elderly and ultimately it doesn't exacerbate the hyperthyroid state.
___________________
92/99/pass/ECFMG certified/4 US LoRs/GC/extensive USCE/2004 grad/appl 29 IM Prog, IV/Rej: 3/0 "I must, I can and I will"
|
| new_n_lost
Forum Hero
Topics: 663
Posts: 6,107
|
Plz go thru this http://www.emedicine.com/med/topic1109.htm#sectio...
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| Ivonne
Find a way or make one
Topics: 58
Posts: 1,611
|
I read the article but it say that treatment is not available in united states. Don't look for the zebra, the horse is in there.
___________________
92/99/pass/ECFMG certified/4 US LoRs/GC/extensive USCE/2004 grad/appl 29 IM Prog, IV/Rej: 3/0 "I must, I can and I will"
|
| hanialkhadher
Forum Elite
Topics: 18
Posts: 259
|
3.-radiactive iodine
___________________
"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
|
| Ivonne
Find a way or make one
Topics: 58
Posts: 1,611
|
RADIACTIVE IODINE(I-131) is taken up by thyroid follicular cells and then destroy them by emitting beta radiation rays.
While this effectively treats hyperthyroidism in the long term, dying thyroid cells release excess thyroid hormone into the circulation, which can temporarly aggravate the hyperthyroid state. Thyrotoxicosis likely explain the new onset of Afib in this patient.
How to avoid this complication?
It is recommended to pre-treat the patient with medications like methimazol to deplete thyroid hormone stores before beginning I-131.
UW q#2352
___________________
92/99/pass/ECFMG certified/4 US LoRs/GC/extensive USCE/2004 grad/appl 29 IM Prog, IV/Rej: 3/0 "I must, I can and I will"
|
| hanialkhadher
Forum Elite
Topics: 18
Posts: 259
|
Thanks Ivonne for this important concept and also for your kind rapid reply
___________________
"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
|
| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,047
|
thanks ivonne... so this is only in elderly patients we give methimazole before radioactive iodine???
cuz in United States drug of choice for hyperthyroidism is ---RADIOACTIVE IODINE right??? alternative PTU or methimazole
|
| Ivonne
Find a way or make one
Topics: 58
Posts: 1,611
|
Yes, neuro I-131 is the treatment of choice in US for hyperthyroidism.
Most common side effects : hypothyroidism, the one discussed previously in the elderly and exacerbation of opthalmopathy. Tha last one can be prevented with high corticosteroids.
UW said that young patient free of cardiovascular problems tolerate I-131 without problems.
___________________
92/99/pass/ECFMG certified/4 US LoRs/GC/extensive USCE/2004 grad/appl 29 IM Prog, IV/Rej: 3/0 "I must, I can and I will"
|
| neuroblastoma
Forum Guru
Topics: 103
Posts: 1,047
|
THANKS BUDDY for clearing the concept..
|
|
| |
| | | | | | | | | | | | | | | | | | | |
